Longitudinal Biomechanics and Patient-Reported Outcomes after Periacetabular Osteotomy for Developmental Dysplasia of the Hip

髋臼周围截骨术治疗髋关节发育不良后的纵向生物力学和患者报告的结果

• 批准号: 10561427
• 负责人: Michael D Harris
• 金额: $ 52.71万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-10 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10561427
• 关键词: Adolescent and Young Adult; Affect; Anterior; Arthritis; Biomechanics; Caring; Cartilage; Data; Deformity; Degenerative polyarthritis; Deterioration; Development; Disease; Dysplasia; Electronics; Femur; Geometry; Goals; Hip Joint; Hip Osteoarthritis; Hip region structure; Intervention; Joints; Magnetic Resonance Imaging; Medial; Modeling; Motion; Musculoskeletal; Operative Surgical Procedures; Osteotomy; Outcome; Outcome Measure; Pain; Patient Monitoring; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Perception; Quality of life; Questionnaires; Reaction; Recovery; Rehabilitation therapy; Reporting; Risk; Shapes; Structure; Surgeon; Symptoms; Testing; Treatment Factor; Work; acetabulum; common treatment; expectation; experience; femur head; hip replacement arthroplasty; improved; improved outcome; joint biomechanics; long term recovery; longitudinal analysis; muscle strength; peer; profiles in patients; success; treatment optimization; wearable sensor technology; young adult

PROJECT SUMMARY / ABSTRACT Developmental dysplasia of the hip (DDH) is a life-long disorder that alters joint biomechanics and increases the risk of early osteoarthritis. The most common treatment for DDH is periacetabular osteotomy (PAO), which surgically reorients the abnormally shaped acetabulum to better cover and stabilize the femoral head. After PAO, patient reported outcome measures (PROMs) improve for many, but not all, patients, and PROMs for most patients remain below the levels of their healthy peers. Recent work has shown that aberrant biomechanical variables, including disproportionate joint reaction forces, high acetabular edge loads, and low abductor muscle strength, are related to specific geometric deformities in DDH prior to PAO. These altered biomechanics are also related to worse PROMs. The current project seeks to optimize surgical care for DDH by determining the effects of, and relationships among, PAO-induced changes to hip geometry, biomechanics, and PROMs. Aim 1 will assess how PAO-induced changes in bony geometry alter hip biomechanics. Geometric and biomechanical profiles for patients (N=60) undergoing PAO will be established before surgery using magnetic resonance imaging, motion capture, and musculoskeletal modeling. Changes to patients’ biomechanical profiles resulting from PAO-induced changes to geometry will be determined at 6 and 12 months post-PAO. Aim 2 will establish target ranges for PAO surgical correction based on the sensitivity of biomechanical outcomes to variability in acetabular reorientation. Surgically feasible combinations of changes to patients’ acetabular geometry will be tested using probabilistic analysis, musculoskeletal models, and high-throughput computing to predict the resultant changes to biomechanics. Aim 3 will determine the relationships among PROMs, activity levels, and biomechanics pre-PAO and over the first 12 months post-PAO. Electronic questionnaires and wearable sensors will be used to monitor PROMs and activity changes as patients recover from surgery. From these data, we will demonstrate how hip biomechanics and activity levels differ in patients with improved PROMs compared to those with unresolved symptoms. Results from the project will inform customized surgical plans according to patients’ initial bony geometry and help surgeons and patients focus on modifiable treatment factors that are associated with improved outcomes. Likewise, new information about variables such as post-PAO activity levels and muscle strength will inform rehabilitation to further improve outcomes. Finally, this project will pave the way for long-term longitudinal analyses of PROMs, biomechanics, and joint structure to inform surgical and rehabilitation approaches that predictably mitigate early hip osteoarthritis.

项目概要/摘要 发育性髋关节发育不良 (DDH) 是一种终生疾病，会改变关节生物力学并增加关节活动度。 DDH 最常见的治疗方法是髋臼周围截骨术 (PAO)。 PAO 后，通过手术重新调整异常形状的髋臼，以更好地覆盖和稳定股骨头。 许多（但不是全部）患者的患者报告结果测量 (PROM) 有所改善，并且大多数患者的 PROM 有所改善 最近的研究表明，患者的生物力学水平仍然低于健康同龄人的水平。 变量，包括不成比例的关节反作用力、高髋臼边缘负载和低外展肌 强度，与 PAO 之前 DDH 的特定几何畸形有关，这些改变的生物力学也与此有关。 当前的项目旨在通过确定效果来优化 DDH 的手术治疗。 PAO 引起的髋关节几何形状、生物力学和 PROM 的变化以及它们之间的关系将成为目标 1。 评估 PAO 引起的骨几何形状变化如何改变髋部生物力学。 将在手术前使用磁共振建立接受 PAO 的患者 (N=60) 的资料 成像、动作捕捉和肌肉骨骼建模导致患者生物力学特征发生变化。 PAO 引起的几何形状变化将在目标 2 确定后 6 个月和 12 个月确定。 根据生物力学结果对变异性的敏感性确定 PAO 手术矫正的目标范围 髋臼重新定向将是对患者髋臼几何形状改变的手术可行的组合。 使用概率分析、肌肉骨骼模型和高通量计算进行测试来预测 目标 3 所产生的生物力学变化将决定 PROM、活动水平和运动之间的关系。 PAO 前和 PAO 后前 12 个月的生物力学 电子问卷和可穿戴传感器。 将用于监测患者从手术中恢复时的 PROM 和活动变化，我们将根据这些数据进行监测。 证明 PROM 改善的患者与那些患者相比，其髋部生物力学和活动水平有何不同 该项目的结果将根据患者的症状制定定制的手术计划。 初始骨几何形状，帮助外科医生和患者关注相关的可修改治疗因素 同样，有关 PAO 后活动水平和肌肉等变量的新信息。 最后，该项目将为长期治疗铺平道路。 分析 PROM、生物力学和关节结构，为手术和康复提供信息 可预见地减轻早期髋骨关节炎的方法。